HIV? Malaria? Tuberculosis? At some point in your life you must have heard about one of these diseases whether it be through increased online exposure, the media or strikingly high mortality rate. Now try leprosy, schistosomiasis or Chagas disease? It is likely you have not and you are not alone. The diseases mentioned are part of a group called Neglected Tropical Diseases (NTD).

NTDs are various infectious diseases caused mainly by viral, protozoa, bacterial or Helminth agents found in low-income countries with tropical and subtropical climates where they are most prevalent. The primary contributing factors of NTD involve inadequate housing, poor hygiene and the lack of accessible clean water. Sadly, it is commonplace for individuals living in poverty to be infected by more than one parasite or infection simultaneously. Although unrecognized by many, NTD has killed 534,000 people on estimate and affected more than 1 billion people worldwide; a burden not only to the health and well-being of many but to the economic growth of low-income countries.

But the question is, WHY is it neglected? There are several factors involved, primarily being the social stigma surrounding the diseases. NTDs often cause physical disfigurement, blindness and impaired cognitive development resulting in alienation from family, friends and society. The consequences that occur are tremendous. Individuals are prevented from receiving educational and employment opportunities, health and social service resources and restricted civil and political rights. Nonetheless, poor mental health encapsulates these patients and reinforces the entrapment within the cycle of poverty.

Consequently, NTDs are rarely found in developed countries, affecting the “bottom billion”—individuals who live less than the World Bank poverty figure of $1.25 per day. Due to the lack of a strong political voice, low socio-economic status and profile of the individuals, they are typically disregarded as a problem, rendering them invisible to a helping hand. Furthermore, with a high morbidity rate but a low mortality rate amongst NTDs, the disease group is overlooked and typically forgotten. In other words, countless individuals are suffering from NTDs and endure a low standard of living but very few experience death by NTDs. In comparison to other diseases such as Zika and Ebola- it is not as horrific or infectious.

On another note, many NTDs are highly treatable and can be prevented with accessible medicine and correct healthcare tools. The Gates Foundation founded by Bill and Melinda Gates has been active in this field where they have implemented a new plan of action in the treatment of multiple infectious diseases which include mass drug administration, public-health surveillance and vector control. The effort exerted by The Gates Foundation has made significant progress in the elimination of leprosy in numerous countries, however this is simply not enough.

For people like us, who are privileged enough to have access to numerous healthcare resources, this problem can seem imperceptible and distant. Yet, it is a harrowing reality faced by far too many. The underlying issue in the Research & Development system is highlighted by the insufficient funds that are put towards research in NTD and the fact that there are rarely new drugs being developed. Ultimately, everyone deserves an equal opportunity at living a healthy life. Therefore, it is essential to raise awareness and gather support from the public, in order to pressure policy makers and pharmaceutical companies into making changes to an unjust and biased system that denies people their basic human rights.

​What is the value of science and technology? Not very much, according to the latest budget proposal from the Trump administration. Whether it is due to President Trump’s inability to comprehend the complexity of the work being done by scientists in America, or simply because he realizes facts produced by the research will negatively impact businesses, one thing is for certain, the new president is not a fan of scientific research.

Many science programs in America will be taking a huge hit due to this proposal including programs listed below:

$5.8 billion reduction in funding to the National Institutes of Health (NIH)

$102 million cut to NASA’s Earth science programs

$900 million reduction in Energy Department’s basic science research

$250 million cut in National Oceanic and Atmospheric Administration (NOAA) grants and programs supporting costal and marine management and research

Environmental protection agency (EPA)

Trump’s vision of the budget sounds economically reasonable, less money for science means more money for other programs such as national defense. However, like many other people, Trump does not realize the impact of basic research on our day-to-day lives.​The NIH will soon experience a reduction of 20% in their overall budget under the Trump administration. Most of the NIH’s budget currently goes towards funding research in health care and universities across the country. For many scientists in biomedical research, this funding provides money to pay salaries, purchase equipment, and train prospective PhD students; ultimately allowing them to conduct cutting edge research. As the years go by, it has become increasingly difficult for scientists to receive funding for their projects. The graph below shows that the amount of NIH funding has plateaued in recent years resulting in a decline in the number of proposal successes. Because of insufficient funding, many interesting and potentially impactful questions are not being investigated.

Unlike the work done in pharmaceutical companies, the research conducted in basic biomedical research is not the kind that will produce a tangible, marketable product. Instead, it allows researchers are able to gather data about the impact of certain substances on organisms, investigate new physiological properties, and uncover new effects of substances being used currently; all of which contribute to improving our quality of life. The scientists then publish the results, whether they are good or bad in order to provide an impartial and objective truth.

Pharmaceutical companies are conducting research with a motive in mind: creating a product that will generate profit. They may resort to tampering data in order to force the numbers to produce a desired result, limiting the sample, ignoring issues with control group participants, and eliminating samples that do not conform to their desired result can achieve a more desirable result. In these companies, the production of a single drug can take up to 10 years of research and cost millions of dollars. Thus if a drug is found to be useless at the last stage of testing, the researchers will be under intense pressure to change the data or leave it unpublished in order to maximize company profit.

As governmental funding for basic research decreases, an increasing number of researchers are forced to turn to industries to fund their work. Industry funding can have dire consequences on the data that is obtained. A 1996 study on the effects of nicotine on cognitive performance revealed that nicotine or smoking improves cognitive performance. However, it is important to note that these scientists were also funded by the tobacco industry. Funding by the industry imparts bias to the researchers, and affects the honestly of their work and results. This means the results are no longer impartial because if the findings from the study don’t look good for the funder’s bottom line, it does not get published.

Health care professionals use the data and conclusions generated by researchers in order to make decisions and treatment plans for their patients. By asking researchers to rely on these alternative means of funding, millions of health care professionals may end up receiving “alternative facts”. Patients may be prescribed useless, or harmful drugs which could have been avoided had the professionals been provided all the accurate and unbiased data.

The Trump administration’s budget proposal is not only shortsighted, but it also fails to recognize the critical role of biomedical research in saving the lives of millions of Americans. Good science cannot happen unless it is divorced from corporate interests. It is a matter of pursuing a finding, instead of a pursuit of knowledge. This budget cut will push scientists to seek alternative means of funding. This not only compromises results, but it also compromises the health of all Americans.

The results of the United States 2016 presidential election were a shock to many around the world. Donald Trump had made no secret of his plans to repeal Obama’s Affordable Care Act, commonly referred to as Obamacare or Medicaid, and in early March the Republican Party finally revealed its new health care plan.

The new Republican bill would reduce the expansion of Medicaid, which has provided coverage to more than 10 million Americans in 31 states, and reduce the federal payments to beneficiaries. The new bill will also remove the requirement for larger employers to offer their full-time employees insurance. Furthermore, the bill aims to undo many of the features in the Affordable Care act that were disfavoured by the wealthy; such as, income-based tax credits that help millions of Americans buy insurance, and the taxes on people with high income. Trump’s new plan will also cut off funding to Planned Parenthood clinics through Medicaid and other government programs for one year.

Although the new bill presents many reforms to Medicaid, it retains three of Medicaid’s most popular features: the prohibition on denying coverage to people with pre-existing conditions, the ban on lifetime coverage caps, and the rule allowing young people to remain on their parents’ health plans until the age of 26. The new plan also reduces tax credits for individuals with annual incomes over $75,000 and married couples with incomes over $150,000.​Since the release of this new healthcare plan, there has been a loud outcry from critics that believe the new bill will worsen inequality in America. An article released by the Commonwealth Fund states that the American government spends more money on health care than most other first-world nations, yet has one of the lowest average life spans among first world nations. A recent article published in the Lancet estimated the average life expectancies of Americans to be on par with individuals living in Mexico by 2030, and a fair degree lower than the average life expectancies of those living in other developed nations. However, this does not mean that the average lifespan of all individuals across America is low. The average lifespan of women in Fairfax, Va., is 85 years, while the average lifespan of women just 350 miles away in the relatively poorer McDowell County, W.Va. is just 72 years. The reason for such a large discrepancy, many believe, is because of the better health care afforded to the rich. Critics of Trump’s new plan assert that his new bill will only exacerbate these differences in health care.

Doctor Cynthia Haq remembers the surge of patients she saw in Wisconsin hospitals after the Affordable Care Act became available: “Hundreds of patients were streaming into our clinics for the first time, some who hadn’t seen a doctor in 20 years.” Nearly, 200,000 Wisconsin residents gained insurance coverage when Obamacare came into effect, most of whom were individuals making around $29,000 per year. She is one of many physicians that worry Trump’s new plan will result in a decrease in visits from lower income patients.​Although Trump’s new plan will undoubtedly decrease the coverage provided to lower income and older Americans, supporters of the bill insist that this is balanced out by the increase in coverage to upper middle class Americans whose workplaces may have provided only minimal coverage, as well as younger Americans. Trump’s new bill is planned to be put into effect in April of this year. Whether the new bills benefits outweigh its costs can only be seen with time.

​Earlier this week, the World Health Organization released a list of 12 antibiotic-resistant organisms, which they have determined to be the "greatest threat to human health." The list contains pathogens such as carbapenem-resistant Enterobacteriaceae (CRE), which invariably kills half the people who are unlucky enough to acquire it. CRE and other such ‘superbugs’ are one of the biggest problems facing the future of medicine. Rapid bacterial evolution results in the emergence of superbugs that carry genes which make them resistant to antibiotics and extremely difficult to treat. In response to the emergence of a number of resistant organisms, the WHO Director General, Margaret Chan, has warned of a “post-antibiotic era” where even common infections could be deadly.

Antibiotic resistance is commonly attributed to antibiotic misuse and overuse. Fingers get pointed at lazy doctors who prescribe antibiotics for common colds and patients who do not adhere to their antibacterial treatment regimens correctly, allowing drug-resistant bacteria to flourish. The intensive farming industry is also to blame for pumping livestock and poultry full of antibiotics to sustain the mass production of meat. The considerable quantities of antibiotics used in factory farming serve to inadvertently create resistance genes that can jump between bacteria-- resulting in the creation of drug-resistant strains that can infect humans.

Although antibiotic misuse is an important cause of antibiotic resistance, it is certainly not the only one. Superbugs are a significant threat not only due to bacteria evolving too quickly, but also because antibiotics are evolving too slowly. In the arms race between bacteria and antibacterial agents, the bacteria are winning. To say that the development of antibiotics is lagging would be an understatement-- the antibiotic pipeline is basically bone dry. Both the total number of antibiotics brought to market and the discovery of novel classes of antibiotics have declined precipitously in recent decades. The number of new antibiotics on the market has been declining since the 1980s and almost every currently available antibiotic is derived from a class discovered before the mid 1980s. When bacteria become resistant to antibacterial agents, they tend to be resistant to multiple agents in the same class. Without the development of new types of antibiotics with unique mechanisms of action, we don’t stand a fighting chance against drug-resistant organisms.

The WHO’s list of 12 superbugs published earlier this week classifies drug-resistant bacteria based on the urgency of developing antibacterial agents. This list is part of a global action plan and a call to spur the pharmaceutical industry to focus their efforts on the development of new essential antibiotics. One of the key reasons for the lack of progress in antibiotic development, is the retreat of the pharmaceutical industry en masse from antibiotic development. Of the 18 largest pharmaceutical companies, 15 had cancelled their antibacterial research & development programmes by the early 2000s. There is simply not a sustainable return on investment for antimicrobial drugs, compared with drugs for chronic conditions and cancer which can be sold for higher prices, have a larger market and are prescribed for a longer course than antibiotics. The abandonment of the antibiotic market by the leading pharmaceutical companies left academic institutions and smaller pharmaceutical companies with limited financial backing to bear the brunt of antibiotic development-- unfortunately with little success.

That is not to say that there is no hope. Upon recognizing the potential catastrophic consequences of inaction, governments, industry and international bodies have made steps towards combatting superbugs. Last year at the World Economic Forum, 85 companies in the pharmaceutical and biotechnology industries, signed the “Declaration on Combating Antimicrobial Resistance”, among these signatories were pharmaceutical giants such as AstraZeneca, GlaxoSmithKline and Pfizer. The declaration calls on governments to support R&D of antibiotics through incentivizing drug discovery. This global commitment is promising, and marks a recommitment of many major pharmaceutical companies to antibiotic R&D.

A lack of effective antibiotics to treat increasingly common infections will change medicine as we know it. The emergence of new superbugs and the rapid progression of bacterial antibiotic resistance can certainly be slowed by proper antibiotic stewardship. But a sustainable solution to the problem of antibiotic resistance must include the development of new antibiotics, including those in different drug classes with novel mechanisms of action. The lack of antibiotic alternatives can be explained by the pharmaceutical industry’s reticence to fund the development of new antibiotics. There must be a massive push from government and industry to revolutionize the antibiotic market through implementing financial incentives and regulatory policies that support antibiotic development. Without major changes in the drug development pipeline we will be powerless in the fight against superbugs.